Neurologic Manifestations

Pulmonary Manifestations

General Comments

Epidemiology

Pulmonary Complications (and Hospitalizations) are Common After Spinal Cord Injury

In a Canadian Study, Approximately 27.5% of Patients with Spinal Cord Injury were Hospitalized within 1 Year After Discharge, with 11.% of the Hospitalizations Being Due to a Respiratory Etiology (Spinal Cord, 2009) [MEDLINE]

In the US, the Overall Hospitalization Rate from 5-20 Years After Injury was 20-25%, with 8.1% Being Due to a Respiratory Etiology (Arch Phys Med Rehabil, 2004) [MEDLINE]

Pulmonary Diseases are the Second Most Common Cause of Death After Spinal Cord Injury, After Cardiovascular Diseases) (J Spinal Cord Med, 2006): pulmonary disease accounts for 20-30% of the mortality which occurs beyond the first year after injury [MEDLINE]

Respiratory Failure is Common After Spinal Cord Injury: both acutely and chronically after the injury

Physiology

Acute Spinal Cord Injury Results in Flaccid Paralysis of All Muscles Caudal (Distal) to the Site of Spinal Cord Injury, Including the Respiratory Muscles: extent of ventilatory respiratory impairment depends on the level and severity of cord injury

Ventilatory Impairment is Most Common and Severe with Complete Cervical Cord Injuries, But May Also Occur in Thoracic Cord Injuries

Factors Contributing to Improvement in Respiratory Muscle Function in the Weeks Following Spinal Cord Injury

Decreased Spinal Cord Inflammation with Functional Descent of the Level of Neurologic Injury

Evolution from Flaccid Paralysis (Spinal Shock) to Spastic Paralysis

Abdominal and Intercostal Muscle Become Less Flaccid, Resulting in Rib Cage Stabilization

Increased Recruitment of Accessory Ventilatory Muscles

Retraining of Deconditioned Muscles

Pneumonia

Epidemiology

Risk of Pneumonia is the Highest in the First Year After Injury, But Remains High Over the Lifetime of the Patient with Spinal Cord Injury (Arch Phys Med Rehabil, 1994) [MEDLINE]*